{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T06:59:38Z","timestamp":1781247578797,"version":"3.54.1"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Herzzentrum G\u00f6ttingen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Posterior trans-iliac plate osteosynthesis (TPO) is commonly used for the stabilization of unilateral vertically unstable sacral fractures. However, its biomechanical performance across different Denis fracture patterns remains unclear. This study aimed to investigate the fracture pattern\u2013dependent biomechanical behavior of posterior trans-iliac plate osteosynthesis (TPO) in unilateral vertically unstable sacral fractures, using bilateral triangular osteosynthesis (BTO) as a high-stability reference construct.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A validated three-dimensional finite element model of the lumbopelvic complex was developed to simulate unilateral vertically unstable sacral fractures corresponding to Denis type I, II, and III patterns. Two posterior fixation strategies, TPO and BTO, were constructed for each fracture type. Seven physiological loading conditions were applied, including standing, flexion, extension, axial rotation, and lateral bending. Von Mises stress distribution and fracture displacement were evaluated. Fracture micromotion was quantified by calculating relative displacement changes between paired points along the fracture gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>When interpreted relative to the high-stability BTO reference construct, TPO showed fracture pattern\u2013dependent variation in fracture displacement. The difference was most pronounced in Denis type I fractures and progressively decreased in Denis type II and III patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The biomechanical performance of posterior trans-iliac plate fixation is influenced by the Denis fracture pattern. Fracture micromotion associated with the non-reinforced TPO construct evaluated in this study decreased as the fracture line approached the sacral midline, indicating improved mechanical compatibility in more medially located fracture patterns. These findings provide biomechanical reference data for understanding fracture pattern\u2013dependent fixation compatibility of TPO in unilateral sacral fractures. However, it remains unclear how much fixation strength is actually required to achieve sufficient construct stability for fracture healing and how postoperative management strategies, such as weight-bearing status, may influence this requirement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03238-w","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T06:18:57Z","timestamp":1781245137000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Denis pattern\u2013dependent biomechanical behavior of posterior trans-iliac plate fixation compared with bilateral triangular osteosynthesis in unilateral sacral fractures: a finite element study"],"prefix":"10.1007","volume":"52","author":[{"given":"Jie","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai O.","family":"B\u00f6ker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arndt F.","family":"Schilling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zully","family":"Ritter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehool","family":"Acharya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Lehmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"issue":"1","key":"3238_CR1","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1007\/s00402-025-05988-5","volume":"145","author":"D Nebel","year":"2025","unstructured":"Nebel D, Ferle M, Schulz T, Welke B, Graulich T, Decker S. Comparative biomechanical evaluation of the U-shaped lumbopelvic stabilization technique in treating unstable sacral fractures. Arch Orthop Trauma Surg. 2025;145(1):372. https:\/\/doi.org\/10.1007\/s00402-025-05988-5.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"Suppl 1","key":"3238_CR2","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","volume":"32","author":"EG Meinberg","year":"2018","unstructured":"Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1\u2013170. https:\/\/doi.org\/10.1097\/BOT.0000000000001063.","journal-title":"J Orthop Trauma"},{"issue":"4","key":"3238_CR3","doi-asserted-by":"publisher","first-page":"253","DOI":"10.5371\/hp.2017.29.4.253","volume":"29","author":"E Hermans","year":"2017","unstructured":"Hermans E, Biert J, Edwards MJR. Epidemiology of Pelvic Ring Fractures in a Level 1 Trauma Center in the Netherlands. Hip pelvis. 2017;29(4):253\u201361. https:\/\/doi.org\/10.5371\/hp.2017.29.4.253.","journal-title":"Hip pelvis"},{"issue":"1","key":"3238_CR4","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.22037\/aaem.v12i1.2243","volume":"12","author":"W Tienpratarn","year":"2024","unstructured":"Tienpratarn W, Nakpipat N, Yuksen C, Wongwaisayawan S, Phootothum Y, Jaiboon S. Clinical Associated Factors of Tile B\/C Type of Pelvic Ring Fractures; a Retrospective Cross-sectional study. Archives Acad Emerg Med. 2024;12(1):e49. https:\/\/doi.org\/10.22037\/aaem.v12i1.2243.","journal-title":"Archives Acad Emerg Med"},{"issue":"7","key":"3238_CR5","doi-asserted-by":"publisher","first-page":"388","DOI":"10.11622\/smedj.2021024","volume":"63","author":"A Singh","year":"2022","unstructured":"Singh A, Min Lim AS, Huh Lau BP, O\u2019Neill G. Epidemiology of pelvic and acetabular fractures in a tertiary hospital in Singapore. Singapore Med J. 2022;63(7):388\u201393. https:\/\/doi.org\/10.11622\/smedj.2021024.","journal-title":"Singapore Med J"},{"key":"3238_CR6","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/00003086-198802000-00010","volume":"227","author":"F Denis","year":"1988","unstructured":"Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67\u201381.","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"3238_CR7","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.31616\/asj.2023.0024","volume":"17","author":"N Beucler","year":"2023","unstructured":"Beucler N, Tannyeres P, Dagain A. Surgical Management of Unstable U-Shaped Sacral Fractures and Tile C Pelvic Ring Disruptions: Institutional Experience in Light of a Narrative Literature Review. Asian spine J. 2023;17(6):1155\u201367. https:\/\/doi.org\/10.31616\/asj.2023.0024.","journal-title":"Asian spine J"},{"issue":"6","key":"3238_CR8","doi-asserted-by":"publisher","first-page":"112317","DOI":"10.1016\/j.injury.2025.112317","volume":"56","author":"M Naisan","year":"2025","unstructured":"Naisan M, Kramer A, Kindel S, Richter M, Ringel F, Hartung P. Comparing different minimally invasive screw osteosyntheses methods for the stabilization of the sacral fractures. Injury. 2025;56(6):112317. https:\/\/doi.org\/10.1016\/j.injury.2025.112317.","journal-title":"Injury"},{"issue":"1 Suppl","key":"3238_CR9","doi-asserted-by":"publisher","first-page":"S45","DOI":"10.1016\/j.otsr.2015.12.002","volume":"102","author":"H Pascal-Moussellard","year":"2016","unstructured":"Pascal-Moussellard H, Hirsch C, Bonaccorsi R. Osteosynthesis in sacral fracture and lumbosacral dislocation. Orthop Traumatol Surg research: OTSR. 2016;102(1 Suppl):S45\u201357. https:\/\/doi.org\/10.1016\/j.otsr.2015.12.002.","journal-title":"Orthop Traumatol Surg research: OTSR"},{"issue":"1","key":"3238_CR10","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1007\/s00064-014-0307-2","volume":"27","author":"YP Acklin","year":"2015","unstructured":"Acklin YP, Marco G, Sommer C. Double locking plate fixation of sacral fractures in unstable pelvic ring C-type injuries. Operative Orthopadie und Traumatologie. 2015;27(1):74\u20139. https:\/\/doi.org\/10.1007\/s00064-014-0307-2.","journal-title":"Operative Orthopadie und Traumatologie"},{"issue":"Suppl 1","key":"3238_CR11","doi-asserted-by":"publisher","first-page":"S106","DOI":"10.1016\/j.jcot.2019.05.017","volume":"10","author":"VM Khaleel","year":"2019","unstructured":"Khaleel VM, Pushpasekaran N, Prabhu N, Pandiyan A, Koshy GM. Posterior tension band plate osteosynthesis for unstable sacral fractures: A preliminary study. J Clin Orthop trauma. 2019;10(Suppl 1):S106\u201311. https:\/\/doi.org\/10.1016\/j.jcot.2019.05.017.","journal-title":"J Clin Orthop trauma"},{"issue":"9","key":"3238_CR12","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1097\/BOT.0b013e318158abcf","volume":"21","author":"D Krappinger","year":"2007","unstructured":"Krappinger D, Larndorfer R, Struve P, Rosenberger R, Arora R, Blauth M. Minimally invasive transiliac plate osteosynthesis for type C injuries of the pelvic ring: a clinical and radiological follow-up. J Orthop Trauma. 2007;21(9):595\u2013602. https:\/\/doi.org\/10.1097\/BOT.0b013e318158abcf.","journal-title":"J Orthop Trauma"},{"issue":"1 Suppl","key":"3238_CR13","doi-asserted-by":"publisher","first-page":"S44","DOI":"10.1097\/01.bot.0000202392.24999.7c","volume":"20","author":"TA Schildhauer","year":"2006","unstructured":"Schildhauer TA, Josten Ch, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma. 2006;20(1 Suppl):S44\u201351.","journal-title":"J Orthop Trauma"},{"issue":"7","key":"3238_CR14","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1097\/00005131-200608000-00001","volume":"20","author":"TA Schildhauer","year":"2006","unstructured":"Schildhauer TA, Bellabarba C, Nork SE, Barei DP, Routt ML Jr, Chapman JR. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma. 2006;20(7):447\u201357. https:\/\/doi.org\/10.1097\/00005131-200608000-00001.","journal-title":"J Orthop Trauma"},{"issue":"40","key":"3238_CR15","doi-asserted-by":"publisher","first-page":"e5026","DOI":"10.1097\/MD.0000000000005026","volume":"95","author":"W Song","year":"2016","unstructured":"Song W, Zhou D, He Y. The biomechanical advantages of bilateral lumbo-iliac fixation in unilateral comminuted sacral fractures without sacroiliac screw safe channel: A finite element analysis. Medicine. 2016;95(40):e5026. https:\/\/doi.org\/10.1097\/MD.0000000000005026.","journal-title":"Medicine"},{"issue":"12","key":"3238_CR16","doi-asserted-by":"publisher","first-page":"2055","DOI":"10.1016\/j.injury.2014.10.052","volume":"45","author":"L Zhang","year":"2014","unstructured":"Zhang L, Peng Y, Du C, Tang P. Biomechanical study of four kinds of percutaneous screw fixation in two types of unilateral sacroiliac joint dislocation: a finite element analysis. Injury. 2014;45(12):2055\u20139. https:\/\/doi.org\/10.1016\/j.injury.2014.10.052.","journal-title":"Injury"},{"issue":"1","key":"3238_CR17","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1186\/s13018-018-0858-2","volume":"13","author":"T Wu","year":"2018","unstructured":"Wu T, Ren X, Cui Y, Cheng X, Peng S, Hou Z, Han Y. Biomechanical study of three kinds of internal fixation for the treatment of sacroiliac joint disruption using biomechanical test and finite element analysis. J Orthop Surg Res. 2018;13(1):152. https:\/\/doi.org\/10.1186\/s13018-018-0858-2.","journal-title":"J Orthop Surg Res"},{"key":"3238_CR18","doi-asserted-by":"publisher","first-page":"1035614","DOI":"10.3389\/fsurg.2022.1035614","volume":"9","author":"Y Sun","year":"2022","unstructured":"Sun Y, Fu Y, Liu F, Zhang W, Ma H, Li Q, Zhou D, Fu B. Biomechanical tests and finite element analyses of pelvic stability using bilateral single iliac screws with different channels in lumbo-iliac fixation. Front Surg. 2022;9:1035614. https:\/\/doi.org\/10.3389\/fsurg.2022.1035614.","journal-title":"Front Surg"},{"issue":"5","key":"3238_CR19","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1272\/jnms1923.57.476","volume":"57","author":"A Takayama","year":"1990","unstructured":"Takayama A. Nihon Ika Daigaku zasshi. 1990;57(5):476\u201385. https:\/\/doi.org\/10.1272\/jnms1923.57.476.","journal-title":"Nihon Ika Daigaku zasshi"},{"key":"3238_CR20","doi-asserted-by":"publisher","first-page":"105350","DOI":"10.1016\/j.clinbiomech.2021.105350","volume":"85","author":"B Venayre","year":"2021","unstructured":"Venayre B, Koyama Y, Kurosawa D, Hammer N, Lingslebe U, Murakami E, Ozawa H, Ohashi T. Quantitative evaluation of the sacroiliac joint fixation in stress reduction on both sacroiliac joint cartilage and ligaments: A finite element analysis. Clin Biomech (Bristol Avon). 2021;85:105350. https:\/\/doi.org\/10.1016\/j.clinbiomech.2021.105350.","journal-title":"Clin Biomech (Bristol Avon)"},{"issue":"1","key":"3238_CR21","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1186\/s12891-023-06884-y","volume":"24","author":"Y Ma","year":"2023","unstructured":"Ma Y, Huang T, Liu W, Hong H, Zhao Y, Lin J, Li Y. Biomechanical effects of S1 sacroiliac screws versus S2 sacroiliac screws on sacroiliac screws combined with a lumbar iliac fixation in the treatment of vertical sacral fractures: a biomechanical finite element analysis. BMC Musculoskelet Disord. 2023;24(1):750. https:\/\/doi.org\/10.1186\/s12891-023-06884-y.","journal-title":"BMC Musculoskelet Disord"},{"issue":"5","key":"3238_CR22","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/j.otsr.2013.03.023","volume":"99","author":"Y Zhao","year":"2013","unstructured":"Zhao Y, Zhang S, Sun T, Wang D, Lian W, Tan J, Zou D, Zhao Y. Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: a finite element analysis. Orthop Traumatol Surg research: OTSR. 2013;99(5):601\u20136. https:\/\/doi.org\/10.1016\/j.otsr.2013.03.023.","journal-title":"Orthop Traumatol Surg research: OTSR"},{"issue":"1","key":"3238_CR23","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1186\/s13018-021-02655-4","volume":"16","author":"J Li","year":"2021","unstructured":"Li J, Xu C, Zhang X, Xi Z, Sun S, Zhang K, Fang X, Xie L, Liu Y, Song Y. Disc measurement and nucleus calibration in a smoothened lumbar model increases the accuracy and efficiency of in-silico study. J Orthop Surg Res. 2021;16(1):498. https:\/\/doi.org\/10.1186\/s13018-021-02655-4.","journal-title":"J Orthop Surg Res"},{"issue":"9","key":"3238_CR24","doi-asserted-by":"publisher","first-page":"e70098","DOI":"10.1002\/cnm.70098","volume":"41","author":"Y Su","year":"2025","unstructured":"Su Y, Tsirikos AI, Koutsos V, Pankaj P. Development and Assessment of a Novel Generic Finite Element Spine Model for Clinical Applications. Int J Numer Methods Biomed Eng. 2025;41(9):e70098. https:\/\/doi.org\/10.1002\/cnm.70098.","journal-title":"Int J Numer Methods Biomed Eng"},{"key":"3238_CR25","doi-asserted-by":"publisher","first-page":"104360","DOI":"10.1016\/j.jmbbm.2021.104360","volume":"117","author":"AK Roth","year":"2021","unstructured":"Roth AK, Beheshtiha AS, van der Meer R, Willems PC, Arts JJ, Ito K, van Rietbergen B. Validation of a finite element model of the thoracolumbar spine to study instrumentation level variations in early onset scoliosis correction. J Mech Behav Biomed Mater. 2021;117:104360.","journal-title":"J Mech Behav Biomed Mater"},{"issue":"1","key":"3238_CR26","doi-asserted-by":"publisher","first-page":"e70022","DOI":"10.1002\/jsp2.70022","volume":"8","author":"J Yang","year":"2025","unstructured":"Yang J, B\u00f6ker KO, Li X, Zhou X, Lehmann W. Unilateral Lumbo-Pelvic Fixation for Denis Type I Unilateral Sacral Fracture: A Finite Element Analysis. JOR spine. 2025;8(1):e70022. https:\/\/doi.org\/10.1002\/jsp2.70022.","journal-title":"JOR spine"},{"issue":"3","key":"3238_CR27","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1115\/1.2794181","volume":"117","author":"M Dalstra","year":"1995","unstructured":"Dalstra M, Huiskes R, van Erning L. Development and validation of a three-dimensional finite element model of the pelvic bone. J Biomech Eng. 1995;117(3):272\u20138. https:\/\/doi.org\/10.1115\/1.2794181.","journal-title":"J Biomech Eng"},{"key":"3238_CR28","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1186\/1471-2474-14-217","volume":"14","author":"H Chen","year":"2013","unstructured":"Chen H, Wu L, Zheng R, Liu Y, Li Y, Ding Z. Parallel analysis of finite element model controlled trial and retrospective case control study on percutaneous internal fixation for vertical sacral fractures. BMC Musculoskelet Disord. 2013;14:217. https:\/\/doi.org\/10.1186\/1471-2474-14-217.","journal-title":"BMC Musculoskelet Disord"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03238-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-026-03238-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03238-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T06:18:59Z","timestamp":1781245139000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-026-03238-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3238"],"URL":"https:\/\/doi.org\/10.1007\/s00068-026-03238-w","relation":{},"ISSN":["1863-9941"],"issn-type":[{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]},"assertion":[{"value":"25 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The CT data used for finite element model construction were fully anonymized and did not contain identifiable personal information. This study did not involve prospective human participation or intervention. Therefore, ethics approval and informed consent were not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"186"}}